Table 3. Multivariable Odds Ratios for Association of PSS Score and of Change in Perceived Stress With Incident Cognitive Impairment at Most Recent Assessment (N = 16 150).

Model	Odds ratio (95% CI)
	PSS score (low vs elevated stress from score at most recent follow-up)	Change in PSS score
		Per unit change	Dichotomized into low vs elevated stress
Unadjusted model	1.19 (1.04-1.36)	1.07 (1.05-1.09)	1.62 (1.46-1.80)
Adjusted model 1: sociodemographic variables including age, sex, educational level, race, and income	1.27 (1.10-1.47)	1.03 (1.01-1.05)	1.41 (1.24-1.59)
Adjusted model 2: model 1 and CVD risk factors including hypertension, diabetes, and hyperlipidemia	1.22 (1.05-1.42)	1.03 (1.01-1.05)	1.38 (1.22-1.57)
Adjusted model 3: model 2 and lifestyle factors including exercise, BMI, smoking, and alcohol use	1.17 (1.00-1.36)	1.04 (1.02-1.06)	1.39 (1.22-1.58)
Adjusted model 4: model 3 and depressive symptoms	1.15 (0.98-1.36)	1.04 (1.02-1.06)a	1.39 (1.22-1.58)b

Abbreviations: BMI, body mass index; CVD, cardiovascular disease; PSS, Perceived Stress Scale.

^a P value for interaction terms in model 4 for continuous PSS score, change in perceived stress: age, P = .30; sex, P = .30; and race, P = .99.

^b P value for interaction terms in model 4 for dichotomized PSS score, change in perceived stress: age, P = .69; sex, P = .31; and race, P = .07.